HomeMy Public PortalAbout4881 FRATUS DR_Sewer__ D
IS&E 669 I I-95
APPLICATION FOR PERMIT 1
5&E 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer p
County of Los Angeles BUILDING O f
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL �^
DESCRIPTION LOT NO OWNER T �Lr leC1r
MAIL �j '
BLOCK TRACT 3�?/ ADDRE PC
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS -' - /D •� DISTRICT NOGROUP MAP
,_ I IPG
CONTRACTOR �Je. L�}�..-.„��.i _ 2 BK 6 S_
I CONNECTION DATA
ADDRESS r- P
STATION 3 b. , DEPTH
CITY TEL NO
�J c r MANHOLE REFERENCE `� - PPE
REGISTRATION NO J� ^' C'-V� C3 STATE R
` Q
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO •""9f� Y CURB P L M L TOP L
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO '19'B-lFG. 2=Z �J
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER a $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS DATE INS ECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER �. 51 .c f'._a.._._
SIGNED THIS DAY 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE HAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL ElAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
ABANDON HOUSE SEW
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑ _
OF PERMITTE -
I
JOHN A LAMBIE, COUNT NGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK b 0 CASH
1,114"0 9 1 3 5 JUN 11 4 4.5 U 10